Although the current Intensive Care environment focuses on providing the best care, the current sounds in that environment do not contribute to an optimal patient experience, leading to high stress levels. Literature study showed that soundscape augmentation can reduce patients’ stress in healthcare settings if implemented correctly. This project focuses on designing and validating such a system for critically ill patients in the Adult Intensive Care. Throughout the project, key stakeholders are considered; patients, healthcare professionals and loved ones.

A soundscape is defined as the acoustic environment as perceived or experienced and/or understood by a person or people, in context (ISO 12913, 2014). The current acoustic environment has been outlined through a context study, along with its impact on key stakeholders. Together, this provided a clear understanding of the existing ICU soundscape. It can be stated that the current ICU soundscape hinders healing because it affects patients’ psychological well-being.

Existing interviews from the Critical Alarms Lab, which aims at shaping the future of soundscapes in these environments, are used to explore patient experiences in ICUs. Four unfulfilled psychological human needs were identified as the barriers to a positive ICU experience: lack of autonomy, comfort, recognition and stimulation. Following literature, these unfulfilled psychological human needs can be fulfilled by providing the right sonic ambience at the right moment. Together with the context study outcomes, a comprehensive patient journey map was created to gain insights into when those psychological needs are either fulfilled or unfulfilled. Interventions in ICU soundscapes need a tailored approach because psychological needs are constantly changing over time and do not arise and disappear at the same time for everyone. A personalized approach was needed to improve the ICU experience.

Four key interaction moments were defined: Patients before admission, loved ones at the start of the admission, healthcare professionals during admission and patients during admission. Several prototypes were created to conduct usability tests with fellow students and healthcare professionals. Insights were gained on which prototype provided the highest engagement and which technique was most intuitive and useful for integrating the system into the healthcare workflow.

A new brand identity was created, resulting in the final design: Amadé - A Soundscape Augmentation System that provides personalized soundscapes, tailored to patients’ needs. By aligning soundscapes with patient preferences and clinical needs, Amadé reduces stress and improves patient comfort. User interfaces were created, focusing on the right tone of voice for each interaction moment. An evaluation test was conducted with ex-ICU patients in multiple online sessions. There was a positive response to the usability of the interfaces, but distrust of the system’s effectiveness emerged. The feedback and insights gathered from these tests resulted in recommendations for future research and a project reflection.

The intensive care unit (ICU) is a dehumanizing technical environment causing complications that are all captured in the term post-intensive-care syndrome (PICS). The patient’s well-being could be improved by moving away from this hostile environment toward more patient-centred care. Therefore this report explores how to improve the daily ICU experience from a critically ill patient’s perspective.

Environmental influences in the ICU, like noise exposure, are important contributors to PICS (Abuatiq, 2015). Hearing is the most prominent sense of ICU patients. Thus, the Erasmus ICU is designed to keep sound out. It has been shown that there is no clear relationship between reduced volume levels and physiological improvement (Drahota et al., 2012), and the absence of sound does not necessarily create a positive environment (Truax, 1984). Therefore, this project aims to consider sound in a positive manner since sound is only perceived as noise when it does not fit the patient’s state of being.

After many former patients were interviewed and an Erasmus MC ICU nurse was observed, it turned out that it is hard for patients not to focus on their feelings of frustration, loneliness, discomfort, shame, panic, confusion etcetera and still keep a positive mindset. Thus, the design aimed to redirect the patient’s focus by connecting the patient to the environment.

The Thirteen Fundamental Needs for Human-Centered Design typology was utilized as a source to design a positive experience for the ICU environment. Six fundamental needs (Stimulation, Recognition, Relatedness, Autonomy, Security, and Comfort) were uncovered. Strengthening these needs could improve the patients’ experience.

Mapping a patient’s daily routine showed that need fulfilment changes according to the eventfulness, the presence, or absence of people or sound inside the ICU. A patient’s journey revealed that the absence of people right after leaving causes the most harm to the patient. Thus, the decision was made to focus on this transition moment.

Eventfulness can be determined by measuring sound pressure levels (SPL) in dB in the ICU. So the transition moment from an eventful (high SPL) to an uneventful (low SPL) environment can be detected and vice versa.

New visual/auditory stimuli were developed. These can be introduced to benefit patients’ recovery (Arbabi et al., 2018). The stimuli consist of sounds of nature in combination with a nature-based projection. The audio and the visual stimuli change according to the SPL in the room. This design intervention helps guide the patient into the new environment. It is a subtle way to notify the patient that something is happening. Furthermore, it can distract the patient (when bored or during treatment) and decrease the difference between higher and lower sound pressure levels.

The design was developed, embodied, and finally tested in a simulated ICU environment. The evaluation of the design intervention showed that all participants appreciated the design intervention, mainly because they were distracted from boredom, stress/anxiety, negative thoughts (loneliness) or discomfort. It made the experience more comfortable or relaxed.

Finally, three use cases were presented, redirecting the focus from anxiety, boredom, and loneliness. Additionally, recommendations were made.